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Research estimates that approximately 9.4% of women giving birth in the United Kingdom have one or more limiting longstanding illness which may cause disability, affecting pregnancy, birth and early parenting (Redshaw et al., 2013).

Research highlights a maternity gap in the service provision for these women using maternity services (Royal College of Midwives, 2005; Royal College of Nurses, 2007).

Anecdotal evidence to support this is widely shown throughout social media where women experiencing difficulties are exploring other means of help they are not able to access through standard NHS healthcare provision.


I have Cerebral Palsy and am excited about my pregnancy but am worried about how I am going to cope with the baby after it is born. I use elbow crutches and am finding it difficult to find information. My midwife was unsure how to advise me” – Mumsnet


Methods

St. George’s University Hospitals NHS Foundation Trust Maternity Unit assists nearly 5000 women to give birth every year.  An innovative and collaborative service between Occupational Therapy (OT) and Maternal Medicine Midwives is currently being piloted to better address the need of pregnant ladies with pre-existing physical and sensory impairments.

Through early screening, women coming into pregnancy with these needs will be offered a link into a collaborative ante-natal assessment by an Occupational Therapist and a Midwife.

OT core skills in maximising independence are utilised in an innovative way to anticipate and address potential issues early in the pathway thus reducing later complications in physical, psychological, antenatal and postnatal care.

Assessment explores enabling the expectant mother to care more independently for their child after birth – including transferring and carrying the baby (indoors and outdoors); feeding, changing, bathing and dressing the baby, as well as strategies and equipment which may be beneficial during the latter stages of pregnancy and delivery.


Results

Since September 2016, the pilot project has so far seen 18 expectant mothers, with a variety of conditions, through the joint OT and Maternal Medicine clinic.  Assessment and advice provided as also varied dependent on the mother’s needs.

Graph to show pre-existing conditions of mothers referred to the OT/Maternity clinic

Graph to show advice/ topics discussed in OT/Maternity Assessment

Women who have come through the clinics have so far been very positive about the information & advice they have received.  Education sessions have been completed with midwives who have joined the clinics. Feedback from service users, midwives and the wider Trust services has been very positive.  As such the project will continue beyond the original 12 month pilot.


Key contributors

Cheryl Edwards – Principal Occupational Therapist (cheryl.edwards@stgeorges.nhs.uk)

Elizabeth Lyle – Specialised Occupational Therapist

Trudy Williams – Maternal Medicine Midwife


References

Redshaw M, Malouf R, Gao H and Gray R (2013) Women with disability: the experience of maternity care during pregnancy, labour and birth and the postnatal period.  BMC Pregnancy Childbirth. 2013 Sep 13;13:174

Royal College of Midwives (2000 reviewed 2005) Position paper 11a; maternity care for women with disabilities, London: RCM

Royal College of Nurses (2007)  Pregnancy and Disability: RCN guidance for midwives and nurses. London: RCN